内窥镜与视频喉镜在困难气管插管中的应用效果比较

目的：比较内窥镜和视频喉镜在困难气管插管中的应用效果。方法40例特重烧伤预测为困难气道、需行经气管插管的全麻患者，随机分为D组（内窥镜）和E组（视频喉镜）。两组采用相同的快速诱导方法进行气管插管。通过监测呼气末二氧化碳确认插管成功。记录从开口置入到气管插管成功的时间，同时，记录插管前后血流动力学的变化、牙齿及口咽部有无损伤等并发症发生情况。结果 D组和E组各插管20例，总成功率分别为100%和95%，一次成功率分别为95%和90%，平均插管时间分别为（20.5±5.6）s和（25.7±6.4）s，分别有2例和4例患者出现插管并发症。与E组比较，D组插管时间较短，并发症发生率少，差异有统计学意义。两组在总成功率、一次成功率比较差异无统计学意义。两组患者插管前后血压无显著变化，E组插管后即刻的心率较插管前有明显增加（P〈0.05），两组比较血压、心率变化差异无统计学意义。结论使用内窥镜气管插管具有操作简单、安全、损伤小的优点，尤其在烧伤患者的困难气道方面具有较多的优势，提高患者的安全性。

Objective To investigate the clinical application of Discoscope endoscope and Eian video laryngoscope in difficult tracheal intubation. Methods Forty severe burn patients with difficult airway who require general anesthesia through intubation were randomly divided into group D （Discoscope endoscope） and group E （Eian video laryngoscopeo）. Both groups use the same method for inducing rapid intubation. Successful intubation was confirmed by monitoring end-tidal carbon dioxide. A stopwatch was used to record the time from the opening into successful intubation. Hemodynamic changes and complications such as teeth and oropharyngeal injury were also recorded. Results Twenty patients were intubated in each group. The total success rate,one-time success rate and average intubation time was 100%and 95%,95%and 90%,20.5±5.6s and 25.7±6.4s,respectively in group D and group E. Two and four patients had intubation complications in group D and E,respectively. Compared with group E,group D had shorter intubation time and less incidence of complications,and was statistically significant. The differences in total success rate and one-time success rate were not statistically significant in two groups. The blood pressure before and after intubation was not significantly changed in two groups. The heart rate immediately after intubation in group E was significantly increased compared to before intubation （P〈0.05）. The differences in changes of blood pressure and heart rate were not statistically significant between the two groups. Conclusion Discoscope endoscope has advantages of simple operation,safety and small injury,especially in difficult airway of severe burn patients,which improves patient safety.